FCC ID: YUH-Q152 HF RFID Reader Module

Technical Documentation for metraTec QR15 v2 HF RFID Module Date: August 2022 Version: 1.3 Technical Documentation metraTec QR15 Page 1 of 24 Table of Contents 1 General Information / Security Advice................................................................3 1.1 Notes on the Use of this Documentation......................................................3 1.2 Security Advice............................................................................................. 3 1.3 Export Restriction......................................................................................... 3 1.4 Further Documentation................................................................................ 3 2 Product Description............................................................................................ 4 2.1 Product Revision History / Migrating from prior Revisions............................4 2.2 Intended Use................................................................................................ 5 2.3 Technical Specification................................................................................. 5 2.4 Pin assignments and description..................................................................7 2.5 Mechanical Specification............................................................................ 11 2.6 Scope of Delivery....................................................................................... 12 2.7 Accessories................................................................................................ 12 3 RFID Integration Hints...................................................................................... 13 4 Power Supply and Power Consumption............................................................14 4.1 Hints for additional EMC filtering................................................................14 5 Communication................................................................................................ 16 6 Digital Inputs / Outputs (GPIOs)........................................................................17 7 Certification...................................................................................................... 18 7.1 CE / ETSI (EU)............................................................................................. 18 7.2 FCC (USA)................................................................................................... 18 7.3 IC (Canada)................................................................................................ 18 8 Further Notes................................................................................................... 19 9 Version History................................................................................................. 20 Technical Documentation metraTec QR15 Page 2 of 24 1 General Information / Security Advice 1.1 Notes on the Use of this Documentation This user manual and integration guide uses different symbols to point out potentially dangerous situations. The following signs and symbols are used throughout the document. ATTENTION Declares a potentially hazardous situation. If this is not avoided, the product or something in its surrounding could be damaged. NOTES Declares notes for the user as well as other useful information, where no harmful or dangerous situations can be expected. 1.2 Security Advice The QR15 HF RFID Module was not designed for use in dangerous environments. Using this product in applications where a failure could directly result in severe injuries or death (high risk activities) is not permitted. This includes but is not limited to applications in nuclear facilities, flight control systems, life support systems or weapon systems. The manufacturer denies the suitability of this device for such scenarios. 1.3 Export Restriction The QR15 HF RFID Module contains components that underlie US export restrictions. It is therefore forbidden to export the product to countries that are on the US trade embargo list. The same applies to any countries that are on the EU embargo list. 1.4 Further Documentation While this documentation explains the electrical and mechanical characteristics of the QR15 module, it might be useful to also read the metraTec Protocol Guide, which explains the ASCII protocols used to control the module in full detail. Source: http://www.metratec.com Support Downloads Documentation Technical Documentation metraTec QR15 Page 3 of 24 2 Product Description The QR15 HF RFID Module is an easy to use RFID module which can be integrated into your electronics without big effort. This allows you to equip your product with RFID functionality without designing your own RF board. Thanks to the tested and extremely flexible firmware you can read and write data to any tag that follows the ISO 15693 standard in no time. Even special features, e.g. sensor tags, can be used without firmware modifications. With its internal antenna a read range of up to 100mm is possible. Thanks to the fast firmware, the module is perfect for applications in printers and similar devices where high reading and writing speed is needed. 2.1 Product Revision History / Migrating from prior Revisions This document applies to QR15 v2 revisions starting from 01.00. All future revisions 1.xx will be according to this documentation. The hardware revision is printed on the board or can be checked using the Read Hardware Revision (RHR) command. Compared to its predecessors revision QR15 modules feature the following improvements:

switchable RF output power level up to 100 mm read range increased RX sensitivity two switchable Receivers improved EMI / EMC behaviour default 5V UART interface for 100% backward compatibility to QR15 v1 or 3V3 UART hardware option for glueless interfacing to 3V3 microcontrollers Technical Documentation metraTec QR15 Page 4 of 24 Fig. 1: QR15 v2 top view 2.2 Intended Use The QR15 HF RFID Module reads RFID tags that comply to the ISO 15693 standard on a short range of 30-80 mm. Custom tag commands can be used without firmware changes if the tags follow the ISO 15693 standard with regard to the air interface. For transponders that use the ISO 14443A or a protocol with MIFARE technology, please use our QR14 RFID Module. 2.3 Technical Specification Supply voltage Supply Current Standby Min. 4.7 V Typ. 5.0 V 20mA Max. 5.5 V Supply Current RF on 135 150mA 160mA 200mW Supply Current RF on 95 110mA 120mA 100mW Technical Documentation metraTec QR15 Page 5 of 24 RF output power 200mW 150mW 200mW 225mW V_In_low (GPIO)

-0.3 V 0 V_In_high (GPIO) 2.3 V 3.3 V V_out_low (GPIO) V_out_high (GPIO)

2.9 V Operating Temperature (1)

-25C 0 3.3 V 20C 0.9 V 3.45 V 0.4 V 3.45 V

+85C Antenna port impedance Internal antenna, Carrier frequency (2) 2250 mm2 13.56 MHz Supported RFID Protocol ISO 15693 Dimensions 50,08 x 50,08 mm Antenna Connector n.a. Communication Interface (3) 5V UART Humidity Non-condensing

(1) RFID performance may vary with temperature, check in application

(2) assigned worldwide

(3) SPI available on request Technical Documentation metraTec QR15 Page 6 of 24 2.4 Pin assignments and description All connectors are standards 2.54mm pin headers with 9.2 mm mating length. Pins are marked in the top layer for reference. An Eagle library is available for easy integration into PCB designs. Fig. 2: QR15 v2 Pin Positions and Naming (top view) Technical Documentation metraTec QR15 Page 7 of 24 Power connector is the two position pin header X1. Pin Name Pin Nr. Pin PCB Pin Pin Function Direction Marking P_GND X1.1 PWR

power supply GND, internally connected to G_GND

+5V X1.2 PWR

main supply, connect low noise regulated 5V supply Tab. 1: Power Supply Pins UART connector is the three position pin header X2. Pin Name Pin Nr. Pin PCB Pin Function Direction Marking U_GND X2.1 Pass. G UART GND, NOT internally connected to P_GND and G_GND TXD X2.2 out T 5V UART Transmit data output 100 Ohm series protection resistor and EMI low pass filter RXD X2.3 in R 5V UART Receive data input Tab. 2: UART Pin connections GPIO connector is the nine position pin header X3. Pin Name Pin Nr. Pin PCB Pin Function Direction Marking G_GND X3.1 Pass. G GPIO GND, internally connected to P_GND GPIO_0 X3.2 I/O none 3.3V GPIO, direction is configurable via FW command, alternate functions on request, Technical Documentation metraTec QR15 Page 8 of 24 GPIO_1 X3.3 I/O none 3.3V GPIO, high drive pin, 15mA drive strength direction is configurable via FW command, alternate functions on request, high drive pin, 15mA drive strength GPIO_2 X3.4 I/O none 3.3V GPIO, direction is configurable via FW command, alternate functions on request, 4mA drive strength GPIO_3 X3.5 I/O none 3.3V GPIO, direction is configurable via FW command alternate functions on request, 4mA drive strength GPIO_4 X3.6 I/O none 3.3V GPIO, direction is configurable via FW command, alternate function: SPI clock (SCK), 4mA drive strength, Technical Documentation metraTec QR15 Page 9 of 24 GPIO_5 X3.7 I/O none 3.3V GPIO, direction is configurable via FW command, alternate function: SPI slave select

(SSEL), alternate function: RS485 transmit driver enable (TXDEN), 4mA drive strength GPIO_6 X3.8 I/O none 3.3V GPIO, direction is configurable via FW command, alternate function: SPI clock Master In Slave Out (MISO), 4mA drive strength GPIO_7 X3.9 I/O 7 3.3V GPIO, direction is configurable via FW command, alternate function: SPI Master Out Slave In (MOSI), 4mA drive strength Tab. 3: Overview of digital input/output pins Technical Documentation metraTec QR15 Page 10 of 24 2.5 Mechanical Specification PCB dimensions as well as pin positions remain unchanged compared to prior revisions of the QR15. Fig. 3: Mechanical DimensionsQR15 v2 Technical Documentation metraTec QR15 Page 11 of 24 2.6 Scope of Delivery The QR15 HF RFID Module comes with the following parts:

QR15 HF RFID Module Documentation, Drivers and Demo Software are available via download from metraTec's website 2.7 Accessories The following accessories and modules are available to extend and evaluate the functionality of the QR15 HF RFID Module:

UDB Mini Evaluation Board HF Field Detector different RFID tags suitable for almost every application Technical Documentation metraTec QR15 Page 12 of 24 3 RFID Integration Guide 3.1 General Hints The QR15 features an onboard antenna emitting a magnetic field at 13.56MHz. Therefore the design should have no loops of wires or traces close to the module. This could lead to unintended inductive coupling and affect the function of the RFID module, the host and cause EMI problems. There should be no wires or traces crossing the area behind the module, traces will detune the internal antenna and reduce reading performance. The same applies to metallic parts of substantial size close to the module. There should be no ground planes parallel to the module, keep the module area clear of copper in all PCB planes. The module features complete shielding of all RF circuitry which is necessary for the FCC modular approval. However, copper plane and shield cage of the module were designed to work with the onboard antenna. The effect of adding additional metallic parts is rather unpredictable. Please contact metraTec if you have doubts that all of the above hints can be incorporated into your design. 3.2 List of applicable FCC rules and ISED radio standards HF RFID applications should comply to:

US/FCC: 47 CFR 15.225 - Operation within the band 13.110-14.010 MHz CAN/ISED: RSS-210 (Issue 10) Licence-Exempt Radio Apparatus: Category I Equipment 3.3 Specific operational use conditions Not applicable. 3.4 Limited module procedures Not applicable. 3.5 Trace antenna designs Not applicable. Technical Documentation metraTec QR15 Page 13 of 24 3.6 RF exposure considerations US/FCC:

The conduced/radiated output power of the device is far below the FCC radio frequency exposure limits. Nevertheless, the device should be used in such a manner that the potential for human contact during normal operation is minimized. CAN/ISED:

This equipment complies with ISED radiation exposure limits set forth for an uncontrolled environment. This equipment should be installed and operated with minimum distance of 1 cm between the radiator and your body. This transmitter must not be co-located or operating in conjunction with any other antenna or transmitter. Cet quipement est conforme aux limites d'exposition aux rayonnements ISED tablies pour un environnement non contrl. Cet quipement doit tre install et utilis avec un minimum de 1 cm de distance entre la source de rayonnement et votre corps. Ce transmetteur ne doit pas tre place au meme endroit ou utilise simultanement avec un autre transmetteur ou antenne. 3.7 Antennas The module may only be operated using the internal antenna. 3.8 Label and compliance information The host product must be labeled with:

Contains FCC ID: YUH-Q152 Contains IC: 9278A-Q152 Technical Documentation metraTec QR15 Page 14 of 24 3.9 Information on test modes and additional testing requirements Not applicable. 3.10 Additional testing, Part 15 Subpart B disclaimer This modular transmitter is only FCC/ISED authorized for the specific rule part/radio standards specification listed on the grant/certificate. The host product manufacturer is responsible for compliance to any other FCC rules/ISED radio standards specifications that apply to the host not covered by the modular transmitter grant of certification. If the host product manufacturer markets their product as being Part 15 Subpart B compliant (when it also contains unintentional-radiator digital curcuity), then the host product manufacturer shall provide one of the following notices

(whichever is applicable in the user manual:

Class A:

For a Class A digital device or peripheral, the instructions furnished the user shall include the following or similar statement, placed in a prominent location in the text of the manual:

Note: This equipment has been tested and found to comply with the limits for a Class A digital device, pursuant to part 15 of the FCC Rules. These limits are designed to provide reasonable protection against harmful interference when the equipment is operated in a commercial environment. This equipment generates, uses, and can radiate radio frequency energy and, if not installed and used in accordance with the instruction manual, may cause harmful interference to radio communications. Operation of this equipment in a residential area is likely to cause harmful interference in which case the user will be required to correct the interference at his own expense. Class B (use in a residential environment):

For a Class B digital device or peripheral, the instructions furnished the user shall include the following or similar statement, placed in a prominent location in the text of the manual:

Technical Documentation metraTec QR15 Page 15 of 24 Note: This equipment has been tested and found to comply with the limits for a Class B digital device, pursuant to part 15 of the FCC Rules. These limits are designed to provide reasonable protection against harmful interference in a residential installation. This equipment generates, uses and can radiate radio frequency energy and, if not installed and used in accordance with the instructions, may cause harmful interference to radio communications. However, there is no guarantee that interference will not occur in a particular installation. If this equipment does cause harmful interference to radio or television reception, which can be determined by turning the equipment off and on, the user is encouraged to try to correct the interference by one or more of the following measures:

Reorient or relocate the receiving antenna. Increase the separation between the equipment and receiver. Connect the equipment into an outlet on a circuit different from that to which the receiver is connected. Consult the dealer or an experienced radio/TV technician for help. Technical Documentation metraTec QR15 Page 16 of 24 4 Power Supply and Power Consumption The module does not feature a reverse polarity protection. It is the task of the host board to supply a well filtered 5 V DC supply in order to achieve an optimum RFID performance. All internal voltages are derived from the 5V supply using onboard regulators. However, RFID systems require a very high level supply quality. Use linear regulators with high precision and high control speed whenever possible. When using switching power supplies make sure the switching speed is above 500 kHz and use an EMC optimized layout as well as shielded inductors. 4.1 Hints for additional EMC filtering The QR15 Module contains an RF generator at 13.56 MHz which also generates harmonics. These will be radiated from the module below all current certification limits. When integrating the module into another device with long cables or big ground planes, radiated emissions might increase. It is advisable to follow good layout practices and add additional EMC filtering to comply with all relevant norms. Common mode supply filters are required in most cases to comply with basic radiated emission rules. The following picture shows radiated emissions of a QR15 RFID engine mounted on a metraTec evaluation board. In most cases the hosts power and UART ground are identical. A four wire connection to the QR15 using +5V, P_GND, RXD and TXD only is best in that case. A 1nF ceramic cap is forming a low pass filter with a series ferrite bead at TXD. This cap is referenced to U_GND. Hosts wanting to use that cap for preventing RF leaking via UART lines may connect the UART ground via U_GND. The U_GND pin is not internally connected to the QR15 GND signal. The rise time is somewhat larger using that option. Attention should be taken not to introduce a GND loop by using U_GND and G_GND connections. Technical Documentation metraTec QR15 Page 17 of 24 EN55011; 10m; Klasse A; Gruppe 1 EN55011; 10m; Klasse B; Gruppe 1 RBW: 120 kHz, Vertical Max Peak 60 50 40 30

m V B d

d e F l i l a c i r t c e l E 20 10 0 30 M 50 M 100 M 200 M 300 M 500 M 1 G Frequency (Hz) Fig. 4: Radiated Emissions of QR15 RFID engine on metraTec evaluation board at full output power (200mW), 2250 mm2 antenna area Technical Documentation metraTec QR15 Page 18 of 24 5 Communication The QR15 HF RFID Module communicates with its host using a 5V UART connection. This enables direct connection to a host microcontroller. The communication details of the serial interface are given in the table below. Min. Typ. Max. Baudrate (1) 114 000 115 200 116 500 Databits Parity Stopbits 1

(1) Others on request 8 None 1 1.5 There is a range of circuits available to convert the 3.3 V UART Signal to RS232, RS422/485 or to USB or Ethernet. A RS485 driver enable signal is available as alternate pin function on GPIO_5 pad. Please contact metraTec if you need advice on converter circuits. The UART commands used to control the QR15 Module are described in the metraTec Protocol Guide. This guide comprises a detailed description of all commands, response formats and examples. As this protocol is shared among several metraTec products the guide is available in a separate document from metraTec's website. A 3V3 UART interface hardware option is available for glueless interfacing to 3V3 microcontrollers. Technical Documentation metraTec QR15 Page 19 of 24 6 Digital Inputs / Outputs (GPIOs) The QR15 Module has eight freely configurable input/output pins which can be set and read via the module. To use these GPIOs just connect your signals to the corresponding vias (X3). All signals are 3V3 signals. ATTENTION Please make sure that you only connect 3.3V level devices to the GPIOs or use the right level shifter if connecting other devices. Some industrial devices use 24 V DC inputs/outputs. If you connect these without proper protection, this will most likely destroy the Dwarf15. Alternative pin functions are available. Project specific firmware is needed for alternate functions. Please contact metraTec. GPIO functionality and direction setting is disabled when an alternate function for a pin or pin group is selected. Not all functions can be combined. Technical Documentation metraTec QR15 Page 20 of 24 7 Certification ATTENTION Changes or modifications to the module not expressly approved by metraTec could void the users authority to operate the equipment. 7.1 CE / ETSI (EU) The QR15 HF RFID Module complies with ETSI EN 300 330. Nonetheless, the integrator of the module has to make sure that all requirements are met by the final product. It is his obligation to declare product conformity. We recommend to assign this task to a qualified third-party test lab specialized on EMC measurements. 7.2 FCC (USA) To fulfill all FCC requirements the integrator must test the final product to comply with FCC regulations regarding intentional and unintentional radiators before declaring FCC compliance of his own product. The module meets the requirements for an FCC modular approval as a single-

modular transmitter. Please contact metraTec in case a modular approval is beneficial for your integration project. 7.3 IC (Canada) Certification requirements for Industry Canada (IC) are similar to those of the FCC. Limits of ICES-003 for radiated emissions are similar to the formats specified in FCC Part 15 and CISPR 22. Industry Canada accepts FCC test reports or CISPR 22 test reports for compliance with ICES-003. The integrator is responsible for its product to comply with all relevant IC rules. Technical Documentation metraTec QR15 Page 21 of 24 8 Further Notes Electronic devices like the QR15 HF RFID Module are covered by the (German) ElektroG (electronic waste law) as well as the European WEEE directive and as such may not be disposed of by way of the normal household trash. Instead they have to be recycled properly. For you as our customer this is no additional burden, however, as you can send the device back to us for proper recycling. We assure you that the devices received back will be recycled properly and in an environmentally friendly way. Our WEEE Registration ID is DE 56060482. When selecting electronic components we additionally made sure that all components are free of heavy metals and other harmful substances as required by the RoHS Directive for many industries. Hence, our products are produced in the most environmentally friendly way possible. Technical Documentation metraTec QR15 Page 22 of 24 9 Version History Versio n 1.0 1.1 1.2 1.3 Change created UART voltage level changed to 5V default fo backward compatibility UART filter and GND description adapted to 5V version FCC/ISED module integration added Changed by TM TM TM TM Date 2.10.2020 19.4.2021 9.8.2021 31.8.2022 Technical Documentation metraTec QR15 Page 23 of 24 Contact metraTec GmbH Niels-Bohr-Str. 5 D-39106 Magdeburg, Germany Tel.: +49 (0)391 251906-00 Fax: +49 (0)391 251906-01 Email:

Web: http://www.metratec.com support@metratec.com Copyright 2016 metraTec GmbH Reprint or reproduction of this documentation for other than internal purposes is only allowed with written permission by metraTec GmbH. All trademarks are the property of their respective owners. All right reserved. MIFARE Classic, MIFARE Ultralight, and MIFARE Plus are registered Trademarks of NXP B. V. and are used under license. We are constantly improving our products. Changes in function, form, features can happen without prior notice. Technical Documentation metraTec QR15 Page 24 of 24

LONG-TERM CONFIDENTIALITY REQUEST for Certification Service in the USA Federal Communication Commission Equipment Authorization Division, Application Processing Branch 7435 Oakland Mills Road Columbia, MD 21048 TO WHOM IT MAY CONCERN Pursuant to Paragraphs 0.457 and 0.459 of the Commissions Rules (47 C.F.R.) and Section 552(b)(4) of the Freedom of Information Act, we request Long-Term Confidentiality for the following product:

Grantee Code Equipment Product Code Check your GC here. Click Grantee Search. FCC ID:

For the product stated above, we request Long-Term Confidentiality for exhibits which contain Block Diagram, Operational Description, Parts List/Tune Up Info, Schematics, SDR Software/Security Info. The above exhibits contain our benefit to our competitors. This information will not be publicly available. trade secrets and proprietary information If you have any questions, please feel free to contact us at the address shown below. Sincerely, Company Name:

Company Address:

Contact Name:

Signature:

Phone:

Fax:

E-mail:

Signature Date:

that could be of Document Version 1.1 2020-10-30

SHORT-TERM CONFIDENTIALITY REQUEST for Certification Service in the USA Federal Communication Commission Equipment Authorization Division, Application Processing Branch 7435 Oakland Mills Road Columbia, MD 21048 TO WHOM IT MAY CONCERN Pursuant to Paragraphs 0.457 and 0.459 of the Commissions Rules (47 C.F.R.) and Section 552(b)(4) of the Freedom of Information Act, we request Short-Term Confidentiality for the following product:

Grantee Code Equipment Product Code Check your GC here. Click Grantee Search. FCC ID:

For the product stated above, we request Short-Term Confidentiality for exhibits which contain External Photos, Internal Photos, Test Setup Photos, User Manual. We request Short-Term Confidentiality on the basis of ensuring that business sensitive information remains confidential until the actual marketing of our new device which is planned for:

We are aware that the Short-Term Confidentiality must be released when the product is marketed. If you have any questions, please feel free to contact us at the address shown below. Sincerely, Company Name:

Company Address:

Contact Name:

Signature:

Phone:

Fax:

E-mail:

Signature Date:

Document Version 1.1 2020-10-30

RSP-100, Issue 12, August 2019 Modular Approval Attestation Federal Communication Commission Equipment Authorization Division, Application Processing Branch 7435 Oakland Mills Road Columbia, MD 21048 Certification and Engineering Bureau Innovation, Science and Economic Development Canada Spectrum Engineering Branch 3701 Carling Avenue, Building 94 Ottawa, Ontario K2H 8S2 Subject: FCC / ISED Modular Approval Statement Grantee Code Equipment Product Code Check your GC here. Click Grantee Search. Check your CN here. FCC ID:

CN:

(Company Number) HVIN:

(Hardware Version Id. Number) HMN:

(Host Marketing Name) UPN:

(Unique Product Number) PMN:

(Product Marketing Name) FVIN:

(Firmware Version Id. Number) TO WHOM IT MAY CONCERN Pursuant to Paragraphs RSP-100, Issue 12 and CFR 15.212, we herewith declare for our module. Modular approval requirement

(a) The radio elements shall have the radio frequency circuitry shielded. Physical/discrete and tuning capacitors may be located external to the shield, but shall be on the module assembly. Yes No *

*Please provide a detailed explanation if the answer is No.:

(b) If the module has modulation/data input(s), they shall be buffered in order to ensure that the module will comply with the requirements set out in the applicable Radio Standards Specification (RSS) and Part 15 under conditions of excessive data rates or over-modulation.

*Please provide a detailed explanation if the answer is No.:

(c) The module shall have its own power supply regulation on the module itself. This is to ensure that the module will comply with the requirements set out in the applicable standard regardless of the design of the power supplying circuitry in the host product that houses the module.

*Please provide a detailed explanation if the answer is No.:

(d) The module shall comply with the provisions for external power amplifiers and antennas detailed in the applicable RSS and rule part. The equipment certification application shall contain:

i. a detailed description of the configuration of highest antenna gain for each type of transmitting antenna for licence-exempt modules;

ii. the maximum transmitting antenna gain for licence modules; and iii. a detailed description of the configuration of lowest antenna gain for each type of receiving antenna for Dynamic Frequency Selection

(DFS) modules with removable antenna(s).

*Please provide a detailed explanation if the answer is No.:

Modular approval requirement

(e) The module shall be tested for compliance with the applicable standard in a stand-alone configuration

(i.e. the module shall not be inside another product during testing). Yes No *

*Please provide a detailed explanation if the answer is No.:

(f) The module complies or will comply with applicable RSS-102 exposure requirements and any applicable FCC RF exposure requirement (1.1307(b), 1.1310, 2.1091, and 2.1093) in its intended configuration/integration in a host.

*Please provide a detailed explanation if the answer is No.:

(g) The module must be labeled with its permanently affixed label (indicating ISED certification number, HVIN and FCC identifier), or use an electronic display (see KDB Publication 784748 and RSP-100, section 5).

*Please provide a detailed explanation if the answer is No.:

(h) The module must comply with all specific rules applicable to the transmitter, including all the conditions provided in the integration instructions by the grantee.

*Please provide a detailed explanation if the answer is No.:

(i) (Only applicable for FCC) The module must contain a permanently attached antenna, or contain a unique antenna connector, and be marketed and operated only with specific antenna(s), per 15.203, 15.204(b), 15.204(c), 15.212(a), 2.929(b). For further information concerning antenna connectors see: DA-00-1087.

*Please provide a detailed explanation if the answer is No.:

If you have any questions, please feel free to contact us at the address shown below Best regards, Company Name:

Company Address:

Contact Name:

Signature:

Phone:

Fax:

E-mail:

Signature Date:

INFO for applicant: Limited Modolar Approval (LMA) may be granted when one or more of the requirements in the table above cannot be demonstrated. LMA will also be issued in those instances where applicants can demonstrate that they will retain control over the final installation of the device, such that compliance of the end product is assured. In such cases, an operating condition on the LMA for the module must state that the module is only approved for use when installed in devices produced by a specificmanufacturer. When LMA is sought, the application for equipment certification must specifically state how control of the end product, into which the module will be installed, will be maintained, such that full compliance of the end product is always ensured. Document Version 2.1 2020-10-30